New article on «Tracing the threads: a system dynamics and network diffusion model of kangaroo care implementation in neonatal care» by Per Block et al.
In a new article, researchers from the Institute for Implementation Science in Health Care IfIS and the Department of Sociology SUZ, Dr. Emanuela Nyantakyi, Prof. Dr. Per Block, Prof. Dr. Lauren Clack, and Dr. Marie-Therese Schultes, investigate the complex factors shaping the implementation of kangaroo care in neonatal intensive care units using system dynamics and network diffusion modeling.
Tracing the threads: a system dynamics and network diffusion model of kangaroo care implementation in neonatal care
Emanuela Nyantakyi (IfIS), Per Block (SUZ), Lauren Clack (IfIS), Marie-Therese Schultes (IfIS, LMU Munich)
First published as an article on March 27, 2026 in Implementation Science Communications
doi.org/10.1186/s43058-026-00907-0
Abstract:
Background
The implementation of evidence-based practices such as kangaroo care (KC), a practice provided in clinical neonatal care, is subject to a complex and dynamic interplay of factors. Using traditional methods to capture and assess this complexity and underlying mechanisms related to implementation, has often proven difficult. This study applied system dynamics and network diffusion modeling to map implementation determinants of KC implementation and to examine underlying implementation mechanisms through which these factors influence the average duration of KC within the complex adaptive implementation system of neonatal intensive care units.
Methods
A causal loop diagram (CLD) was developed through a systems mapping exercise with 32 multiprofessional KC experts and validated through interviews with participants with lived KC experience. The CLD was subsequently converted into a network graph to derive a network diffusion model. The model estimated the influence of cascades initiated by selected variables (‘seeds’) on the outcome variable of Average hours of KC provided.
Results
The CLD comprised 73 variables and 155 connections across three interconnected domains: parental engagement, workforce capacity and service delivery context. In the network diffusion model, Nurses per Shift and Availability of KC Education & Counseling initiated the strongest influential cascades on average time of KC provided.
Conclusions
This study demonstrates the utility of integrating system dynamics and network science to investigate complex mechanisms underlying implementation processes. Further applications are needed to validate and refine these methods and to strengthen their contribution to research surrounding implementation mechanisms.
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